Improving Children's Brushing Frequency Using Internet-based Coaching

Methods: An internet coaching system for home use was developed based on a number of behaviour change techniques, adapted from social cognition models, which have been successfully employed in healthy eating programmes conducted in schools. The system included personalised webpages, parental guidance on use of rewards, planning tool with weekly progress updates, mobile phone reminders and motivating cartoons for children. A controlled, 2-cluster parallel design study was conducted investigating healthy children (age 5-9) who were ‘once-a-day-brushers’ as reported by parents and confirmed by the child. Fifty-seven children used toothbrushes containing data-loggers to determine their baseline brushing frequency over a 2-week period. This was followed by a 3-week intervention phase during which mothers of the test group (28) used the coaching programme in their home environment, versus a control group (29) who continued brushing with the data-logging toothbrush only. Analysis consisted of paired t-tests to determine differences between baseline and intervention brushing frequency and between group comparisons using ANCOVA.

Results: Data for 21 children in the test and 23 in the control group were available for analysis. A significant difference between test and control group was found with regard to change from baseline (F=7.21, p=0.01), with the mean number of brushings in test group increasing from 0.9 to 1.07 whilst the control decreased from 0.94 to 0.77 per day.

Conclusions: A novel internet based intervention designed to help parents guide their children towards better brushing was shown to increase daily brushing. The study highlighted several improvement options to further increase participant engagement.